Who needs adrenaline?
Allergic reactions vary in severity.
In its 2016 guidelines, the British Society of Allergy and Clinical Immunology (BSACI) suggests the following:
People who should be considered for long-term provision of an adrenaline auto-injector include those:
• Who have suffered an anaphylactic reaction where the cause is unknown (known as idiopathic anaphylaxis)
• Who have suffered an anaphylactic reaction where the known allergic trigger cannot easily be avoided
• Who are allergic to high-risk allergic triggers, for example nuts, with other risk factors also present, such as asthma, even if the reaction was relatively mild
• Who had a reaction in response to trace amounts of the allergic trigger
• Where an anaphylactic reaction triggered by food is only likely to occur if that food is eaten around the time of physical exercise (known as Food-Dependant Exercise-Induced Anaphylaxis or FDEIA).
• Where other significant other risk factors are present (e.g. asthma in someone with food allergy)
What dose of adrenaline auto-injector should be prescribed?
In its 2016 guidelines, the British Society of Allergy and Clinical Immunology (BSACI) suggests the following:
| Group | Dose Adrenaline |
| Adult or child> 12 years* | 0.5mg |
| Adult, adolescent or child > 30 kg | 0.3mg |
| Children 15–30 kg** | 0.15mg |
| Children < 15 kg (unlicensed) | 0.15mg |
*0.3 mg more appropriate for a smaller child > 12 years. **0.3 mg may be more appropriate for some children, for example over 25 kg.
How many devices to prescribe?
In its 2017 prescribing guidelines, The UK’s Medicines and Healthcare products Regulatory Agency (MHRA) recommends the following:
• that 2 adrenaline auto-injectors are prescribed, which patients should carry at all times
• ensure that people with allergies and their carers have been trained to use the particular auto-injector that they have been prescribed—technique varies between injectors
• encourage people with allergies and their carers to obtain and practice using a trainer device (available for free from the manufacturers’ websites)
For further detail see the MHRA publication here
When and how to use adrenaline
The varied and unpredictable course of severe allergic reactions makes it difficult to define when adrenaline is best administered. The UK Resuscitation Council recommends giving adrenaline as soon as there is stridor, respiratory distress, wheeze or clinical signs or shock. Urgent transfer to hospital is vital. Visit their site.